血清GRP78、SFRP1对急性肺栓塞患者危险分层的诊断价值及对患者预后不良的预测价值OA

Objective To investigate the diagnostic value of serum glucose regulated protein 78(GRP78)and secreted frizzled-related protein 1(SFRP1)for risk stratification and poor prognosis in patients with acute pulmonary embolism(APE).Methods A total of 120 APE patients admitted to the hospital from June 2023 to June 2025 were selected as the APE group.According to the risk stratification,the patients were divided in-to medium-high risk group(52 cases)and low risk group(68 cases).Another 120 healthy volunteers who un-derwent physical examination in the hospital at the same period were selected as the control group.Baseline data of all subjects were collected.The serum levels of GRP78,SFRP1 and troponin Ⅰ were detected by en-zyme-linked immunosorbent assay.According to the prognosis of the patients during hospitalization,the pa-tients were divided into poor prognosis group and good prognosis group.Multivariate Logistic regression was used to analyze the influencing factors of intermediate-high risk and poor prognosis in APE patients.The re-ceiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of serum GRP78 and SFRP1 alone and in combination for the risk stratification of APE patients into medium and high risk and the predictive value of poor prognosis.Bootstrap method was used to internally verify the combined model of ser-um Foxo4 and MG53 levels.The decision curve analysis(DCA)was used to evaluate the practicability of the prediction model.Results The serum levels of GRP78 and SFRP1 in the APE group were higher than those in the control group,and the differences were statistically significant(P＜0.05).The proportion of patients with pulmonary embolism severity index(PESI)grade Ⅲ-Ⅳ,the proportion of patients with poor prognosis,and the levels of serum troponin Ⅰ,GRP78,and SFRP1 in the medium-high-risk group were higher than those in the low-risk group,and the differences were statistically significant(P＜0.05).Multivariate Logistic regres-sion analysis showed that PESI grade Ⅲ-Ⅳ and elevated serum levels of troponin Ⅰ,GRP78,and SFRP1 were independent risk factors for moderate and high risk risk stratification in APE patients(P＜0.05).The results of ROC curve analysis showed that the AUC of serum GRP78,SFRP1 alone and their combination in the diagnosis of APE patients with medium and high risk stratification were 0.809,0.827,0.904,respectively,and the AUC of the combination of the two was greater than that of the single diagnosis(Z=2.738,2.261,P＜0.05).There were 90 cases in the good prognosis group and 30 cases in the poor prognosis group.The ser-um levels of GRP78 and SFRP1 in the poor prognosis group were higher than those in the good prognosis group,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that elevated serum GRP78 and SFRP1 levels were independent risk factors for poor prognosis in APE patients with moderate to high risk stratification(P＜0.05).ROC curve analysis showed that the AUC of ser-um GRP78,SFRP1 alone and their combination for predicting poor prognosis of APE patients were 0.811,0.808 and 0.916,respectively,and the AUC of the combination prediction was greater than that of the single prediction(Z=2.052,2.060,P＜0.05).DCA confirmed that the combined model of GRP78 and SFRP1 had a high net benefit advantage within a wide range of threshold probabilities(0.10-0.75).Conclusion The ser-um levels of GRP78 and SFRP1 are increased in APE patients,which are closely related to the risk stratifica-tion and prognosis of APE patients.The combination of GRP78 and SFRP1 has high diagnosis and predictive value for the risk stratification and prognosis of APE patients.